This is the fourth in a five-part series on “Finding Addiction Treatment That Works.” Read Part One, Part Two, and Part Three. Are you looking for therapies with a proven track record for helping people recover from drug and alcohol addiction? Are you unsure how to get them for yourself or for a loved one? Today in part four of our series Finding Addiction Treatment That Works, we look at five therapies for treating addiction and dual diagnoses that are based on scientific studies and therefore qualify as “evidence-based” addiction treatment. Here they are, with some concluding pointers for how to ensure you’re getting them:
Cognitive Behavioral Therapy (CBT)
In CBT, patients “develop social and problem-solving skills and tools for stress management, which help change the thoughts and behaviors that contribute to addictive patterns,” according to addiction expert and psychiatrist Dr. David Sack, MD. Numerous large-scale trials have confirmed that CBT is helpful for treating substance use disorders, both on its own and in conjunction with other CBT-related therapies that emphasize different goals (such as motivational interviewing or contingency management, among others featured below). Cognitive behavioral therapies that work can thus include a variety of techniques — like the following featured in an article in Psychology Today:
- Behavioral experiments —Trying out which thoughts are most helpful in fostering a desired behavior like abstinence from drugs or alcohol
- Thought records — Identifying a negative or harmful thought, testing its validity, recording your self-reflections and then replacing that negative thought with a more constructive, positive rationale
- Pleasant activity scheduling — This is as simple as scheduling 10 minutes of daily constructive fun and putting these plans on your weekly calendar
- Situation exposure hierarchies — Naming your biggest fears, rating them, then trying out the least scary on your list and working your way up until you reach your biggest phobia
- Imagery based exposure — Recalling a negative experience, then visualizing the moment in its fullness and your thoughts, feelings and impulses at the time until the pain or trauma of that recollection decreases (thereby reducing avoidance coping tendencies)
Motivational Interviewing (MI)
Case Western Reserve University’s Center for Evidence-Based Practices (CEBP) defines MI as an “evidence-based treatment that addresses ambivalence to change.” The therapeutic approach is mostly conversational, inviting clients into a goal-directed process of engagement that helps them develop the inner resources to make lasting changes in lifestyle. A series of studies published by the National Registry of Evidence-Based Programs and Practices (NREP), an offering of the Substance Abuse and Mental Health Services Administration (SAMHSA), tested the effectiveness of MI for treating drug and alcohol addiction and related problems, such as driving under the influence, as well as MI’s prospects for increasing retention rates in treatment. In each of these studies, MI improved treatment and recovery outcomes.
Community Reinforcement Approach (CRA)
This form of therapy focuses on implementing an environment that is conducive to long-term sobriety from drugs or alcohol and ongoing management of the disease of addiction: it seeks to replace old environmental triggers of substance abuse with new behaviors and relationships that support recovery. To this end, clients identify and build new life skills, interests and support networks. NREP identifies the community reinforcement approach as particularly effective for treating adolescent drug and alcohol addiction and co-occurring disorders (among people ages 22 and younger).
Contingency management provides tangible incentives for reaching treatment goals by rewarding positive behaviors. Depending on the program, incentives might include vouchers for restaurants, movies or other benefits that go along with a drug-free lifestyle. Or they might involve cash or other prize incentives for following through with treatment goals. The idea is to provide clients with positive reinforcement for pursuing a healthy, drug-free lifestyle, and research has demonstrated its effectiveness.
Research has consistently shown that the involvement of a spouse or close family members in the recovery process boosts treatment outcomes. Family therapy raises treatment retention rates, studies have shown, and helps to alleviate systemic issues or sources of relational distress that may have fed an addiction or could cause relapse.
How to Ensure You’re Getting These Essential Five Therapies
If you’re unsure whether a prospective treatment program offers these five therapies essential to addiction treatment that works, call the center and ask. No treatment works for everyone, but access to these therapies will improve your chances of a successful recovery. If a center claims to offer one or more of the above therapies, these follow-up questions may also help:
- Are your clinicians actually trained and certified in each of these therapies, and are their credentials up to date?
- To what extent (how many times throughout a given week and for how long) will clients receive these therapeutic interventions with a therapist or in a group setting?
- How can I be sure that your clinicians follow nationally recognized best practices with respect to each of these therapies?
- “Cognitive-Behavioral Therapy for Substance Use Disorders,” The Psychiatric Clinics of North America
- “Disseminating evidence-based practices in substance abuse treatment: A review with suggestions,” Journal of Substance Abuse Treatment
- “Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine),” National Institute on Drug Abuse
- “Motivational Interviewing,” SAMHSA’s National Registry of Evidence-Based Programs and Practices
- “The Community Reinforcement Approach,” Alcohol Research & Health
Next, the final part of our series “Finding Addiction Treatment That Works,” will focus on those who are ready to leave treatment. What can you insist on in the way of aftercare that works? By Kristina Robb-Dover @saintplussinner